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1. Senior Block- O&G > Menstrual Cycle Disorders > Flashcards

Menstrual Cycle Disorders Flashcards

(51 cards)

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1
Q

At what age should menarche occur?

A

11-13 yrs old

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2
Q

What happens in day 1-4 of a normal, 28 day menstrual cycle?

A

Endometrium shed due to the spiral arteries collapsing and spasming.
Menses occurs

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3
Q

What happens to oestrogen levels in days 5-13 of the menstrual cycle?

A

Rise- causes endometrial lining to develop and follicles to develop in the ovary

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4
Q

Which hormone rises dramatically on day 13 of the cycle to stimulate ovulation?

A

LH

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5
Q

Which hormone is secreted in large amounts in days 15-28 of the menstrual cycle?

A

Progesterone

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6
Q

What happens to the endometrial lining in the secretory phase (days 15-28) of the menstrual cycle?

A

Gains increased blood supply
Swollen glands
Enlarged stromal tissue
(Ready for implantation)

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7
Q

What is the definition of dysfunctional uterine bleeding (DUB)?

A

Any variation from the normal 28 day menstrual cycle.
Eg. post-coital, intermenstrual, post-menopausal, menorrhagia, as well as cycle irregularities (irregular, too long/short)

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8
Q

Give 4 structural causes of dysfunctional uterine bleeding?

A 
PALM
Polyps
Adenomyosis
Leiomyomas (fibroids)
Malignancy + hyperplasia
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9
Q

Give 4 non-structural causes of dysfunctional uterine bleeding?

A 
COEIN
Coagulopathy
Ovulatory dysfunction 
Endometrial- primary disorder of endometrial haemostasis
Iatrogenic
Not yet specified
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10
Q

What is the objective definition of menorrhagia?

A

Loss of >80ml of blood per menstrual cycle

Normal 37-43ml

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11
Q

What is the clinical definition of menorrhagia?

A

Excessive menstrual blood loss which interferes with physical, social or emotional quality of life.

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12
Q

Give 6 causes of menorrhagia?

A 
Fibroids
Endometriosis
Adenomyosis
Polyps
Uterine cancer
Ovarian cancer
Diabetes
IUD
Von Willebrands
Anticoagulation medications
Hypothyroidism
SLE
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13
Q

What symptoms is it good to ask about to confirm menorrhagia?

A

Passing large blood clots
Regularly changing sanitary products
Flooding
Symptoms of anaemia

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14
Q

What investigations is it important to do in menorrhagia?

A

FBC
TVUS –> endometrial lining thickness
Hysteroscopy +/- endometrial biopsy

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15
Q

What is the 1st line medical management of menorrhagia?

A

Mirena coil

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16
Q

What is the 2nd/3rd line medical management of menorrhagia?

A

2nd:
Tranexamic acid
NSAIDs
COCP

3rd:
Progesterones
GnRH analogues

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17
Q

How can menorrhagia be managed surgically?

A

Endometrial ablation
Hysterectomy
Surgically treat cause eg. fibroid removal

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18
Q

What is the definition of irregular menstrual bleeding?

A

Bleeding between periods or irregular cycles

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19
Q

Give 3 potential causes of irregular menstrual bleeding

A 
Anovulatory cycle- no ovulation 
Fibroids
Polyps
Adenomyosis
Ovarian cysts
Gynaecological cancers
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20
Q

How is irregular menstrual bleeding investigated?

A

FBC
Cervical smear
USS
Endometrial biopsy

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21
Q

How is irregular menstrual bleeding managed?

Study These Flashcards
A

IUS
COCP
Progestogens
Surgical options- endometrial ablation, hysterectomy

22
Q

What is the definition of primary amenorrhoea?

Study These Flashcards
A

Menstruation has not started at age 16

23
Q

What is the definition of secondary amenorrhoea?

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A

Menstruation has stopped for >3 months

24
Q

What is the definition of oligomenorrhea?

Study These Flashcards
A

Menstruation only occurs once every 35 days to 6 months

25
Give 6 potential causes of primary amenorrhoea
``` Constitutional delay (delayed puberty) Hypothalamic Hypogonadism Hyperprolactinemia Hypo/hyperthyroidism Adrenal tumours Adrenal hyperplasia PCOS Premature ovarian failure Turner's syndrome Androgen insensitivity Imperforate hymen Transverse vaginal septum ```
26
Give 6 potential causes of secondary amenorrhoea
``` Pregnancy Menopause Lactation Drugs- Progestogens, Antipsychotics Hypothalamic Hypogonadism Hyperprolactinemia Hypo/hyperthyroidism Adrenal tumours PCOS Premature ovarian failure Cervical stenosis Asherman's syndrome ```
27
What is the definition of post-coital bleeding?
Bleeding following intercourse that is not normal menstrual loss.
28
Give 3 causes of post-coital bleeding
Cervical carcinoma Cervical ectropion Cervical polyps Cervicitis
29
How is post-coital bleeding managed?
Cervical smear Treat obvious cause eg. ectropion Colposcopy Histology
30
What is the definition and cause of dysmenorrhoea?
Painful menstruation. Due to high prostaglandin levels in the endometrium secondary to contraction and uterine ischaemia
31
What is primary dysmenorrhoea?
No organic cause found. Often occurs at the start of menstruation and is very common.
32
How is primary dysmenorrhoea managed?
NSAIDs COCP Reassurance to young patients
33
What is secondary dysmenorrhoea?
Pain due to pelvic pathology. Pain precedes menstruation and is relieved by the start of menstruation. Occurs alongside deep dyspareunia, menorrhagia and irregular periods.
34
What are the main causes of secondary dysmenorrhoea?
``` Fibroids Adenomyosis Endometriosis PID Ovarian tumours ```
35
What is the definition of precocious puberty?
Menstruation occurs before the age of 9
36
Give 2 potential pathological mechanisms for precocious puberty
Increased GnRH secretion (meningitis, encephalitis, CNS tumours, hydrocephaly) Increased oestrogen secretion (hormone producing tumours of ovary or adrenal gland)
37
How is precocious puberty managed?
GnRH analogue Removal of tumours Anti-androgenic progestogen
38
What is the definition of premenstrual syndrome?
Psychological, behavioural and physical symptoms experienced on a regular basis when in the luteal phase of menstruation
39
Give 5 clinical features of PMS
``` Bloating GI upset Tender breasts Headaches Spots Altered sex drives Altered appetites Trouble sleeping Mood swings Emotional Irritable Depressed Aggressive ```
40
How can PMS be managed conservatively?
``` Regular exercise Healthy diet No smoking 7-8hrs sleep Reduce stress Reduce alcohol Evening primrose oil ```
41
How can PMS be managed medically?
``` SSRIs COCP GnRH analogues NSAIDs Vitamin B6 CBT- psychological help ```
42
What is the definition of Polycystic Ovary Syndrome?
Polycystic ovaries are defined as having 12 or more 2-8mm follicles on an enlarged ovary seen on a transvaginal ultrasound. Need 2/3 criteria: - PCO on USS - Irregular periods (>35 days apart) - Hirsutism (increased testosterone/clinically)
43
Give 3 risk factors for PCOS
``` Genetic Family Hx Increased stress Insulin resistant Obesity COCP use FHx of diabetes ```
44
What is the suggested pathophysiology of COCP?
High levels of insulin are known to make the ovaries produce excess testosterone. This interferes with follicle development and normal ovulation. High levels of LH also affect normal ovulation.
45
Give 10 clinical features of PCOS
``` Thinning hair Poor eyesight Depression Oily skin Dry eyes Unwanted facial hair (hirsutism) Insomnia Fatigue Anxiety Deeper voice Skin tags Obesity Cramping pains Decreased libido Irregular periods Miscarriages ```
46
Give 4 long term complications of PCOS
``` Infertility Type II diabetes Depression Sleep apnoea High BP High cholesterol Endometrial cancer Ovarian enlargement ```
47
How is PCOS investigated?
``` Bloods: LH (raised) FSH (normal) AMH (raised) Testosterone (raised) TSH Fasting glucose Cholesterol screen ``` Transvaginal ultrasound- string of pearls appearance
48
How is PCOS managed medically?
COCP= regulates menstruation, reverses hursuitism Metformin= restores ovulation, reduces insulin levels Cyproterone acetate= blocks effects of testosterone Spironolactone= blocks effects of testosterone Eflornithine cream= topical antiandrogen
49
How is PCOS managed surgically?
Laparoscopic ovarian diathermy
50
How can fertility be increased in PCOS?
Clomiphene- anti-oestrogen in hypothalamus and pituitary | Gonadotropins- injection of LH and FSH
51
What are the increased complications of PCOS in pregnancy?
Hypertension Preeclampsia Gestational diabetes Miscarriage

1. Senior Block- O&G (11 decks)

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